Welcome back to SpineIQ Back Blog! This week we’ll continue with the September theme of discussing clinically relevant studies with – Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic –  by Cottrell et al.1 The COVID-19 pandemic accelerated the already ever-growing need for telehealth.2 While telehealth can possibly help bridge the access to healthcare gap, many clinicians have legitimate concerns whether clinical exams and patient satisfaction are similar to in-person care.3 This study attempted to determine the agreement between telehealth and in-person care for people with chronic musculoskeletal pain.

Study design

The participants included in the study were assessed consecutively (in-person, telehealth) twice. The assessments were up to the clinician’s discretion which allows this study to be pragmatic and beneficial for readers. The outcomes were also very pragmatic as the study looked at clinical management decisions, need for imaging, need for pathology investigation, and patient satisfaction. Instead of evaluating the agreement between two orthopedic tests, this study assessed if the final clinical management decision was similar (urgent medical care required, expedited but not urgent specialist care, non-surgical specialist management, non-surgical conservative management). These outcomes are useful and pragmatic for readers to be able to determine the usefulness of telehealth for chronic musculoskeletal pain. The study used kappa values to report agreement, which can be interpretated as:

  • 0-20% poor agreement
  • 21-40% fair agreement
  • 41%-60% moderate agreement
  • 61%-80% substantial agreement
  • 81%-100% near perfect agreement


The agreement between telehealth and in-person are incredibly helpful to relieve some of the doubts and questions around potential assessment differences.

Outcome measured Result
Clinical management decision 83.3% agreement
Pathology testing need 97.6% agreement
Imaging need 81% agreement

Additionally, patient satisfaction was measured in 6 different ways:

Confidence in using telehealth 85%
Recommend to friend unable to travel 90%
As good as in-person assessment 70%
Visual clarity 85%
Audio clarity 85%
Overall satisfaction 85%



Telehealth is here to stay and these results should relieve some doubt about the rigor and patient satisfaction compared to in-person examination. While clinicians will always be needed for in-person care, there is large potential for what telehealth and technology can add to clinical practice. Clinicians are no longer limited by travel time distance and can feel confident that their assessments, decision making, and patient satisfaction will remain at a high level. The clinical value and usefulness of Telehealth evaluations are now reliable enough to provide clinician’s confidence in the benefit this process brings. The challenge to telehealth currently is not in the process but rather in the interval between governmental statutory licensure approval and insurance reimbursement for the procedure. Additionally, multiple challenges arise with across state line jurisdictional issues for licensure authority. The value of the process is now no longer in question however, the delay in approval may take time to develop.


  1. Agreement between telehealth and in-person assessment of patients with chronic musculoskeletal conditions presenting to an advanced-practice physiotherapy screening clinic – ScienceDirect. Accessed September 28, 2021. https://www.sciencedirect.com/science/article/abs/pii/S2468781218300961
  2. Piche J, Butt BB, Ahmady A, Patel R, Aleem I. Physical Examination of the Spine Using Telemedicine: A Systematic Review. Glob Spine J. 2021;11(7):1142-1147. doi:10.1177/2192568220960423
  3. Cary M, Darkins A. Telemedicine and Telehealth: Principles, Policies, Performance and Pitfalls.; 2000.